Open primary repair of torn collateral ligament(s), cruciate ligament(s), and/or joint capsule of the knee — all structures addressed in a single operative session.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $896.15
- Total RVUs
- 26.83
- Global, days
- 90
- Region
- Knee
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Specify which ligaments were repaired (ACL, PCL, MCL, LCL) and confirm all were addressed in the same operative session
- Document that the procedure was primary repair of native tissue, not reconstruction or augmentation, and note timing relative to the injury
- Record the surgical approach by name (medial arthrotomy, lateral arthrotomy, etc.) — operative notes that say 'standard approach' are audit flags
- Include intraoperative findings describing the extent and location of ligament/capsule tears for each structure repaired
- Confirm open technique was used; if a scope was introduced for visualization, document that it was not used as a billable arthroscopic procedure
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
27409 covers open primary repair of both collateral and cruciate ligaments and/or the knee capsule performed together. Primary repair means the surgeon directly repairs the torn native tissue at or near the time of injury, before significant scarring or retraction occurs — this is not reconstruction or augmentation. The collateral ligaments (MCL/LCL) run along the medial and lateral joint lines; the cruciates (ACL/PCL) cross inside the joint. Addressing all of them under one code distinguishes 27409 from the individual ligament codes (27405 for collateral-only, 27407 for cruciate-only).
The 90-day global period bundles all routine post-op visits, wound checks, and splint or brace adjustments through day 90. Unrelated E/M services within that window require modifier 24; a significant, separately identifiable E/M on the day of surgery requires modifier 25. If the surgeon also performs an arthroscopic procedure during the same session, note that arthroscopic cruciate codes (29888, 29889) cannot be billed alongside open ligamentous reconstruction codes (27427–27429) — and the same logic applies here: if the case converts from scope to open, bill the open code only. When ACL repair and PCL reconstruction are done together, the correct pairing is 27407 plus 27428, not 27409 alone, because reconstruction and primary repair are distinct service types.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 13.37 |
| Practice expense RVU | 10.61 |
| Malpractice RVU | 2.85 |
| Total RVU | 26.83 |
| Medicare national rate | $896.15 |
| Global period | 90 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $896.15 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $3,695.53 |
Common denial reasons
The recurring reasons claims for CPT 27409 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Unbundling with 27405 or 27407 when all ligaments were repaired in the same session under 27409
- Billing arthroscopic codes (29888, 29889) on the same claim as the open repair — NCCI bundles these
- Missing laterality documentation when bilateral claims are submitted without modifier 50, LT, or RT
- Inadequate operative note failing to distinguish primary repair from reconstruction, triggering medical necessity denial
- Global period violations — billing routine post-op E/M within 90 days without modifier 24
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01When does 27409 apply instead of 27405 or 27407?
02Can I bill an arthroscopic code alongside 27409?
03How do I handle modifier 51 when ACL repair and PCL reconstruction are done together?
04What's the global period for 27409, and what does it include?
05Is 27409 appropriate for both acute traumatic tears and chronic instability?
06How does site of service affect payment for 27409?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/27409
- 03aapc.comhttps://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/overcoming-problems-coding-multiple-knee-ligament-repairs-article
- 04cms.govhttps://www.cms.gov/files/document/2026-ncci-medicaid-policy-manual.pdf
- 05acgme.orghttps://www.acgme.org/globalassets/pfassets/programresources/268_caselogguidelines_orthopaedicsportsmedicine.pdf
Mira AI Scribe
Mira's AI scribe captures the specific ligaments repaired (ACL, PCL, MCL, LCL), the surgical approach by name, intraoperative tear findings, and confirmation of open primary repair technique from the surgeon's dictation. That specificity prevents the most common audit flag on 27409 — operative notes that don't distinguish primary repair from reconstruction and can't support the medical necessity of combining multiple ligament repairs under a single code.
See how Mira captures CPT 27409 documentation